Exercising Safely

Exercise offers many benefits for people who’ve been diagnosed with breast cancer, but it’s important to exercise safely.

Certain exercises may be risky for people who’ve been treated for breast cancer, including:

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  Swimming laps. Although some people may be fine, heavy arm and shoulder work may be too much for other people. If you really like swimming, you may want to try swimming laps while resting your arms on a kickboard or other floating device.

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  Using resistance bands. When pulling on a resistance band, you don’t know how much resistance is being generated. Be sure to start with the lightest resistance band to make sure it isn’t too strenuous for you.

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  Doing body weight exercises such as pull-ups and push-ups. It’s difficult to know how much weight you are moving — the movements may put too much stress on the shoulders and arms. It’s a good idea to work with a trainer to decide if and how you should modify these movements.

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  Doing some yoga posessuch as inversions and downward dog. These poses may put too much weight on the arms. There are yoga teachers who are specially trained to work with people who’ve been treated for breast cancer. They can suggest alternative poses and ways to work up to inversions and downward dog.

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  Using elliptical and cross-training machines, playing tennis, and cross-country skiing. If you’re starting a new exercise program relatively soon after breast cancer surgery, you may want to take care when working the arm on the side where you had surgery with additional exercise. For example, if you start an exercise program designed specifically for breast cancer survivors, you may want to wait until your arm is stronger before using a cross-training machine, playing tennis, or doing anything else that works your arm at the same time. After you’ve been doing the exercise program for a month or so, you may be able to gradually introduce other exercises that work out the arms as well.

If you’ve had breast cancer surgery, you may be at risk for lymphedema — swelling of the soft tissues of the arm, hand, trunk, or breast that may also cause numbness, discomfort, and sometimes infection.

There is concern among some people, including doctors, that strength training — lifting weights in particular — can trigger lymphedema. Still, other people, including doctors, feel the benefits of exercise when done correctly and carefully — even weight lifting — far outweigh the risks.

The PAL trial looked at the benefits of weight lifting for survivors and found that starting very light and progressively lifting heavier weights may be better than not exercising an arm at risk for lymphedema after breast cancer. The PAL trial also found that women who followed the weight lifting plan were stronger, had a healthier body image, and had less body fat than women who didn’t lift weights. Additionally, women who were diagnosed with lymphedema at the start of the PAL trial who followed the weightlifting plan were 50% less likely to have the lymphedema get worse. ¹

Get the OK from your primary care physician and surgeon. It’s important to discuss the exercises you plan to do with both your primary care doctor and your breast surgeon. Ask them if there are any movements you should avoid doing or if you should limit the range of motion they involve. It’s also a good idea to discuss: 

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  any medicines you’re taking to see if any of them may affect your ability to exercise

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  any other medical conditions you may have (such as asthma or osteoporosis) to see if they may affect your ability to exercise

Take any precautions that are necessary. If you’ve been diagnosed with lymphedema or are very worried about it, talk to a lymphedema specialist about any precautions you should consider taking. Some precautions may include wearing a well-fitted compression garment or possibly wearing protective gloves. If something doesn’t feel right, stop immediately and talk to your doctor or lymphedema specialist. You can also read the National Lymphedema Network’s Position Paper on Exercise to learn about their recommended precautions.

Do your warm-ups. Before you do any type of exercise, it’s important to warm up by walking for five to 10 minutes. It’s a good idea to include a complete flexibility program — so you stretch all the major muscle groups — when you warm up.

Make slow and steady progress. Expect to improve gradually. Every person is unique, every breast cancer is unique, and every treatment plan is unique. Don’t measure your progress against what other people can do or to what you could do before you were diagnosed with breast cancer. Give yourself the time you need to recover and get strong, flexible, and healthy.

Focus on form. Perfect form is better than holding a stretch for longer or doing more reps of an exercise. Form should be excellent, even if it means doing less. So if you can only hold a 30-second stretch for 15 seconds unless you bend your knees or arm in a way you’re not supposed to, it’s better to hold the stretch for 15 seconds with perfect form rather than for 30 seconds with bad form.

Stop if you feel pain. Check your form or make your movements smaller so you feel no pain. If it still hurts, you may need to talk to your doctor, physical therapist, or certified personal trainer about modifications.

Rest as needed. If you’re sick with a cold or an infection or feel especially tired, take a day off.

Do your cool-downs. After each exercise session, it’s important to cool down by walking for 5 or 10 minutes and stretching all the major muscle groups.

Tell your instructor you’ve been treated for breast cancer. Regardless of the type of exercise you do, it’s important to let the instructor or certified personal trainer know you’ve been treated for breast cancer. The instructor or personal trainer can show you how to modify certain movements scale down any exercises as needed.